Leukemia

Leukaemia is a type of life-threatening blood cancer that needs early diagnosis and treatment. Below is a short case profile to better understand the disease.

A nineteen-year-old girl was brought to our casualty at Apollo Hospital, Navi Mumbai, in early December 2020 by her parents with complaints that the girl has been having severe joint pains and an unrelenting high-grade fever for the last two weeks. She has also had multiple episodes of vomiting for the past 3-4 days. In addition, the girl has been having prolonged menstruation last eight days. On examination, she was found to be pale and looked tired. She had palpable swellings in the neck and some red petechial spots on her lower limbs. Her basic blood tests showed low haemoglobin (severe anaemia), low platelet count (thrombocytopenia) and a very high white cell count (leukocytosis). A quick look at the peripheral smear on microscopy in the laboratory raised the suspicion of underlying leukaemia (blood cancer). Leukaemias are blood cancers due to mutations in the genes and lead to an exponential and abnormal growth of white blood cells; this hinders the growth and development of normal blood cells in the bone marrow. These leukemic cells do not allow the other blood cells (red blood cells and platelets) to grow and function, leading to anaemia and thrombocytopenia in such patients. In addition, the abnormal rate at which they grow causes an expansion of the bony cavities and thereby causing bony discomfort and pain that these patients present with. Since the WBCs are the body’s infection-fighting cells, their abnormalities affect the patient’s immune system, leading to an impaired ability to fight infections. Thus, often, the high fever in such patients is partly due to the conditions they develop due to their impaired immune system.

We evaluated this patient further with a bone marrow biopsy examination with several molecular tests and confirmed the diagnosis of acute Lymphoblastic Leukaemia (ALL). The patient was admitted to an isolation ward in Apollo Hospital, and treatment was initiated. She underwent 8-week induction chemotherapy, followed by two months of consolidation chemotherapy. Her genetic workup confirmed a high risk ALL, and hence she proceeded with a matched sibling donor stem cell transplant at Apollo hospitals, Navi Mumbai. She is 1-year post-transplant and in complete remission, doing well and on regular monitoring. She has joined her college and pursuing further studies to complete her education.

Although rare among all cancers, Leukaemias can be classified into acute and chronic leukaemias.

Chronic leukaemias include

· Chronic Myeloid leukaemia

· Chronic Lymphocytic leukaemia

Acute leukaemias include

· Acute myeloid leukaemia,

· Acute Promyelocytic leukaemia

· Acute lymphoblastic leukaemia (T cell, B cell)

· Some other mixed leukaemias

Few warning signs to suspect a haematological malignancy: These signs matter more when presenting collectively as more common causes may include viral fever, tuberculosis, autoimmune disorders etc.

– Persistent fever spikes with weight loss

– Rapidly rising white blood cell counts

– New onset swelling in the neck or groin

– Massive splenomegaly causing poor appetite and weight loss

– Easy bruising due to low platelets or impaired coagulation proteins.

– A strong family history of leukaemia

Leukaemias need a timely diagnosis for optimum outcomes. Since the long duration of treatment can be financially and emotionally draining for the families, several such families receive financial support from NGOs and several other organisations. In addition, patients and their families require a lot of social and psychological support to pull through these difficult times. Therefore, a comprehensive Haematology/Oncology unit requires an expert team with Hematologists or Oncologists, an Infectious disease team, oncology nurses, fully functional blood bank, a good intensive care unit backup, dedicated social workers, clinical psychologists and most importantly, an organisation tuned to cancer care.

Inputs by Dr. Punit Jain, Consultant, Hemato-Oncology & Bone Marrow Transplant Physician, Apollo Cancer Centres, Navi Mumbai